Year: 2017
Type: dissertation
Study design: Observational Study
Abstract: Lung transplantation improves health-related quality of life (HRQL), daily function and survival for individuals with advanced lung disease. However, lung transplantation is now offered to older and more complex patients who are at a higher risk of skeletal muscle dysfunction; the implications of which remain uncertain. The overall objective was to assess how elements of muscle dysfunction (mass, strength and function) are associated with pre- and post-transplant physical function, HRQL, and clinical outcomes. We hypothesized that pre-transplant skeletal muscle dysfunction would be associated with impairments in pre-transplant HRQL, activities of daily-living (ADL), six-minute walk distance (6MWD), and worse post-transplant functional recovery with increased pre- and post-transplant mortality. Three studies targeting the pre- and post-transplant periods were undertaken. In study 1, a novel method of muscle mass quantification using computed tomography (CT) was retrospectively evaluated in 527 lung transplant candidates. CT muscle cross-sectional area in transplant candidates was 10% lower than age and sex-matched controls and independently associated with 6MWD, strength training volumes and post-transplant hospital length of stay (LOS), but no association was observed with pre- or post-transplant mortality. In study 2, muscle mass assessed with bio-electrical impedance, quadriceps strength, and function (Short Physical Performance Battery, SPPB) were prospectively evaluated in 50 lung transplant candidates. Quadriceps strength and SPPB were associated with pre-transplant HRQL, ADL, and 6MWD. Number of muscle deficits (mass, strength and/or function) was directly correlated with post-transplant hospital LOS, but not with delisting/mortality or post-transplant 6MWD. In study 3, the impact of pre-transplant skeletal muscle mass and function on post-transplant functional independence, HRQL, and 6MWD was evaluated in a select group of lung transplant recipients with prolonged mechanical ventilation (â Ľ 7 days). Age and intensive care unit (ICU) LOS were the only determinants of early post-transplant functional recovery, highlighting the importance of ICU-acquired morbidity. In summary, these studies demonstrate that skeletal muscle function is an important marker of pre-transplant daily function and predicts post-transplant hospital LOS, but is not a significant predictor of post-transplant function or mortality. Future studies should examine whether targeted rehabilitation strategies in the pre-transplant period may improve daily function and early post-transplant outcomes.
Source: TSpace (University of Toronto)
Author: Dmitry Rozenberg
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2800100094